J. Masin‐Spasovska, O. Stojceva-Taneva, B. Taneva, G. Spasovski
Abstract Cerebrovascular and cardiovascular events are among the most common causes of death in patients with a functioning graft. Hypertension has been well-known as major “traditional” risk factor for atherosclerotic cardiovascular disease being also frequent in kidney transplant recipients. A number of factors may contribute to developing or aggravating hypertension after transplantation. Among them, a central role is played by calcineurin inhibitors, corticosteroids and allograft dysfunction. Apart from the increased risk of myocardial infarction and sudden cardiac death, post-transplant hypertension also has implications on the graft outcome and survival. Considering kidney transplantation as the best treatment option for renal replacement therapy with an improved quality of life and survival compared to other treatments, the management of hypertension becomes crucial issue after kidney transplantation. In addition to pharmacologic and lifestyle interventions, risk reduction may also require tailoring a patient's immunosuppressive regimen to achieve optimal balance between efficacy and adverse events.
{"title":"Hypertension after Kidney Transplantation","authors":"J. Masin‐Spasovska, O. Stojceva-Taneva, B. Taneva, G. Spasovski","doi":"10.1515/mmr-2015-0001","DOIUrl":"https://doi.org/10.1515/mmr-2015-0001","url":null,"abstract":"Abstract Cerebrovascular and cardiovascular events are among the most common causes of death in patients with a functioning graft. Hypertension has been well-known as major “traditional” risk factor for atherosclerotic cardiovascular disease being also frequent in kidney transplant recipients. A number of factors may contribute to developing or aggravating hypertension after transplantation. Among them, a central role is played by calcineurin inhibitors, corticosteroids and allograft dysfunction. Apart from the increased risk of myocardial infarction and sudden cardiac death, post-transplant hypertension also has implications on the graft outcome and survival. Considering kidney transplantation as the best treatment option for renal replacement therapy with an improved quality of life and survival compared to other treatments, the management of hypertension becomes crucial issue after kidney transplantation. In addition to pharmacologic and lifestyle interventions, risk reduction may also require tailoring a patient's immunosuppressive regimen to achieve optimal balance between efficacy and adverse events.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"69 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Petkovska, G. Dimitrov, J. B. Kavrakova, Z. Petronijevic, Djulshen Selim, E. Antova
Abstract Introduction. Post-transplant diabetes (PTDM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are common complications of immunosuppressive therapy (IT) and are associated with increased cardiovascular morbidity and impaired graft function (GF). Methods. Fifty-nine living donor kidney transplant recipients (KTR) were included in a combined cross-sectional and 8-month-observational prospective study about the impact of impaired glucose homeostasis (IGH) on GF. All patients were on standard IT including cyclosporine A (CsA), steroids and mycophenolate mofetil (MMF). In all patients a standard oral glucose tolerans test (OGTT) was performed. Results were classified according to the criteria of the American Diabetes Association: normal-with fasting blood glucose level (FGL) <5.6, IFG with FGL of 5.6-6.9, IGT with FGL of 7.8-11.1 and DM between > 6.9 FGL and >11 mmol/l. According to the results, all patients were divaded into two groups: Group 1 with impaired and Group 2 with normal GH. GF was estimated by GFR-Cockroft Gault (CG) and by degree of proteinuria in the beginning and end of the study. Results. Twenty of 59(33.9%) patients showed overt IGH after transplantation while the remaining 39(66.1) were normal. The principal dysglycemia in KTR were PTDM (2 patients-3.3%), IGT (18 patients-30.5%) and IFG (7 patients-11.8%). In Group 1, postprandial glucose was higher (8.1±2.3 vs 5.8±0.7), more KTR were male (70% vs 33.3%), higher CsA levels were observed (160.9±81.2 vs 115.1±59.9) and time after the surgery was shorter (24.5±21.3 vs 41.4±28.). After a follow-up period of approximately 18 months in Group 1 a significant decline in GFR (62.6-52.7 ml/min) was noted, with no significant change in proteinuria. The correlation analysis was positive between CsA level and IGH and the time after transplantation and IFG. Conclusion. Post-transplant dysglycemia and associated metabolic abnormalities are a significant factor for the deterioration of GF. CsA higher levels are associated with the occurrence of IGH and they affect the GF.
摘要简介。移植后糖尿病（PTDM）、空腹血糖受损（IFG）和糖耐量受损（IGT）是免疫抑制治疗（IT）的常见并发症，与心血管发病率增加和移植物功能受损（GF）有关。方法。59名活体供肾移植受者（KTR）参与了一项关于葡萄糖稳态受损（IGH）对GF影响的横断面和8个月的前瞻性观察研究。所有患者都接受了标准IT，包括环孢素a（CsA）、类固醇和霉酚酸酯（MMF）。对所有患者进行标准口服葡萄糖耐受性试验（OGTT）。结果根据美国糖尿病协会的标准进行分类：正常，空腹血糖水平（FGL）6.9 FGL和>11 mmol/l。根据研究结果，所有患者被分为两组：第一组GH受损，第二组GH正常。在研究开始和结束时，通过GFR-Cockroft-Gault（CG）和蛋白尿程度来估计GF。后果59名患者中有20名（33.9%）在移植后出现明显的IGH，其余39名（66.1）正常。KTR的主要血糖异常为PTDM（2例-3.3%）、IGT（18例-30.5%）和IFG（7例-11.8%），观察到更高的CsA水平（160.9±81.2 vs 115.1±59.9），手术后时间更短（24.5±21.3 vs 41.4±28.）。在第1组约18个月的随访期后，GFR显著下降（62.6-52.7ml/min），蛋白尿无显著变化。CsA水平与IGH、移植后时间及IFG呈正相关。结论移植后血糖异常和相关代谢异常是GF恶化的重要因素。CsA水平升高与IGH的发生有关，并影响GF。
{"title":"Impact of Post-Transplant Dysglycemia on Renal Allogrfat Function in Kidney Transplant Recipients on Cyclosporine-Based Immunosuppression","authors":"L. Petkovska, G. Dimitrov, J. B. Kavrakova, Z. Petronijevic, Djulshen Selim, E. Antova","doi":"10.1515/mmr-2017-0016","DOIUrl":"https://doi.org/10.1515/mmr-2017-0016","url":null,"abstract":"Abstract Introduction. Post-transplant diabetes (PTDM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are common complications of immunosuppressive therapy (IT) and are associated with increased cardiovascular morbidity and impaired graft function (GF). Methods. Fifty-nine living donor kidney transplant recipients (KTR) were included in a combined cross-sectional and 8-month-observational prospective study about the impact of impaired glucose homeostasis (IGH) on GF. All patients were on standard IT including cyclosporine A (CsA), steroids and mycophenolate mofetil (MMF). In all patients a standard oral glucose tolerans test (OGTT) was performed. Results were classified according to the criteria of the American Diabetes Association: normal-with fasting blood glucose level (FGL) <5.6, IFG with FGL of 5.6-6.9, IGT with FGL of 7.8-11.1 and DM between > 6.9 FGL and >11 mmol/l. According to the results, all patients were divaded into two groups: Group 1 with impaired and Group 2 with normal GH. GF was estimated by GFR-Cockroft Gault (CG) and by degree of proteinuria in the beginning and end of the study. Results. Twenty of 59(33.9%) patients showed overt IGH after transplantation while the remaining 39(66.1) were normal. The principal dysglycemia in KTR were PTDM (2 patients-3.3%), IGT (18 patients-30.5%) and IFG (7 patients-11.8%). In Group 1, postprandial glucose was higher (8.1±2.3 vs 5.8±0.7), more KTR were male (70% vs 33.3%), higher CsA levels were observed (160.9±81.2 vs 115.1±59.9) and time after the surgery was shorter (24.5±21.3 vs 41.4±28.). After a follow-up period of approximately 18 months in Group 1 a significant decline in GFR (62.6-52.7 ml/min) was noted, with no significant change in proteinuria. The correlation analysis was positive between CsA level and IGH and the time after transplantation and IFG. Conclusion. Post-transplant dysglycemia and associated metabolic abnormalities are a significant factor for the deterioration of GF. CsA higher levels are associated with the occurrence of IGH and they affect the GF.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"91 - 98"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46190903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Duma, S. Bojadzieva, A. Sofijanova, A. Stamatova, A. Andonovski, O. Jordanova
Abstract Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. Attachments may occur congenitally at the base of the spinal cord (medullary cone) or they may develop near the site of an injury to the spinal cord. These attachments cause an abnormal stretching of the spinal cord. The course of the disorder is progressive. We present two patients that were diagnosed at age of three months and three years, respectively. Final diagnosis was made by magnetic resonance imaging, and both patients were referred to University Clinic of Neurosurgery for further treatment. Our aim is to illustrate the advantages of the early diagnostics of this progressive condition, to present diagnostic methods that are age-dependent and to illustrate the early clinical indicators for its existence.
{"title":"Tethered Cord Syndrome in Children – Report of Two Cases","authors":"F. Duma, S. Bojadzieva, A. Sofijanova, A. Stamatova, A. Andonovski, O. Jordanova","doi":"10.1515/mmr-2017-0024","DOIUrl":"https://doi.org/10.1515/mmr-2017-0024","url":null,"abstract":"Abstract Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. Attachments may occur congenitally at the base of the spinal cord (medullary cone) or they may develop near the site of an injury to the spinal cord. These attachments cause an abnormal stretching of the spinal cord. The course of the disorder is progressive. We present two patients that were diagnosed at age of three months and three years, respectively. Final diagnosis was made by magnetic resonance imaging, and both patients were referred to University Clinic of Neurosurgery for further treatment. Our aim is to illustrate the advantages of the early diagnostics of this progressive condition, to present diagnostic methods that are age-dependent and to illustrate the early clinical indicators for its existence.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"136 - 139"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46711823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Noveski, Vladimir Ginoski, B. Dzonov, E. Mircevska
Abstract Introduction. Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders of adrenal steroidogenesis. In approximately 90-95% of the CAH cases, it is a deficiency of the enzyme steroid 21-hydroxylase. The degree of enzyme insufficiency determines the severity of the disease. In the simple virilizing type of CAH dominant symptoms are virilization in girls and precocious puberty in boys. Virilizing type of CAH is the most common etiology of ambiguous genitalia in women. There are several options for surgical reconstruction of such anomalies, which must always be optimized to the patient’s anatomy, to achieve a good esthetic and functional result. Detailed presentation of the case. The paper presents the case of a 36-year old woman with delayed pediatric diagnosis of simple virilizing type of CAH, due to deficiency of 21-hydroxylase, pronounced phenotypic virilization, clitoromegaly, hyperpigmentation of the external genitalia, vaginal hypoplasia and existence of low confluence of the urethra with the vagina in so called low type of urogenital sinus andbilateral micromastia, also called mammary hypoplasia. The patient underwent augmention mammoplasty, clitoroplasty, reduction of clitoral hood and proximal labioplasty. Discussion. CAH is a continuum of disorders, affecting patients throughout the life. Feminizing genitoplasty includes three parts: clitoroplasty, labioplasty and vaginoplasty. Clitorectomy in modern times is unacceptable option. Conclusion. Surgical management and reconstruction in women with simple virilizing type CAH and ambiguous genitalia remains still controversial and emotionally laden area in reconstructive surgical activity and requires a team approach.
{"title":"Case Report of Feminizing Genital Reconstruction in a Female with Congenital Adrenal Hyperplasia","authors":"L. Noveski, Vladimir Ginoski, B. Dzonov, E. Mircevska","doi":"10.1515/mmr-2017-0023","DOIUrl":"https://doi.org/10.1515/mmr-2017-0023","url":null,"abstract":"Abstract Introduction. Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders of adrenal steroidogenesis. In approximately 90-95% of the CAH cases, it is a deficiency of the enzyme steroid 21-hydroxylase. The degree of enzyme insufficiency determines the severity of the disease. In the simple virilizing type of CAH dominant symptoms are virilization in girls and precocious puberty in boys. Virilizing type of CAH is the most common etiology of ambiguous genitalia in women. There are several options for surgical reconstruction of such anomalies, which must always be optimized to the patient’s anatomy, to achieve a good esthetic and functional result. Detailed presentation of the case. The paper presents the case of a 36-year old woman with delayed pediatric diagnosis of simple virilizing type of CAH, due to deficiency of 21-hydroxylase, pronounced phenotypic virilization, clitoromegaly, hyperpigmentation of the external genitalia, vaginal hypoplasia and existence of low confluence of the urethra with the vagina in so called low type of urogenital sinus andbilateral micromastia, also called mammary hypoplasia. The patient underwent augmention mammoplasty, clitoroplasty, reduction of clitoral hood and proximal labioplasty. Discussion. CAH is a continuum of disorders, affecting patients throughout the life. Feminizing genitoplasty includes three parts: clitoroplasty, labioplasty and vaginoplasty. Clitorectomy in modern times is unacceptable option. Conclusion. Surgical management and reconstruction in women with simple virilizing type CAH and ambiguous genitalia remains still controversial and emotionally laden area in reconstructive surgical activity and requires a team approach.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"131 - 135"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41365302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Spasovski, A. Sivevski, D. Karadjova, I. Samardžiski
Abstract Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.
{"title":"Epidural Anesthesia for Caesarean Section and Occurrence of Horner’s Syndrome","authors":"S. Spasovski, A. Sivevski, D. Karadjova, I. Samardžiski","doi":"10.1515/mmr-2017-0022","DOIUrl":"https://doi.org/10.1515/mmr-2017-0022","url":null,"abstract":"Abstract Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"128 - 130"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47410340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Karadjova, M. Shosholcheva, A. Sivevski, E. Ivanov, I. Kjaev, G. Dimitrov
Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.
{"title":"Patient-Controlled Analgesia (PCA) with Remifentanil Versus Intermittent Epidural Boluses for Labor Analgesia","authors":"D. Karadjova, M. Shosholcheva, A. Sivevski, E. Ivanov, I. Kjaev, G. Dimitrov","doi":"10.1515/mmr-2017-0017","DOIUrl":"https://doi.org/10.1515/mmr-2017-0017","url":null,"abstract":"Abstract Introduction. Remifentanil is becoming more and more popular for labor analgesia as an alternative for neuro-axial anesthesia. In this study we compared the severity of pain, patient satisfaction and side effects between two different types of labor analgesia. Methods. Eightyprimiparous patients ASA I or II, atterm pregnancy, were included in the study and divided in two groups. The first group (35 patients) received intravenous remifentanil on patient control pump in bolus doses. The second group (45 patients) received intermittent epidural boluses with highly diluted local anesthetic and opioid (Bupivacain and Fentanil). We analyzed oxygen saturation (SpO2), respiration rate, heart rate, blood pressure, sedation, nausea and vomiting as well as patient pain scores and satisfaction scores through 2 different VAS. Results. Mean SpO2 was significantly lower in the PCA remifentanil group 96.2%±1.6 versus 98.2±1.2 in the epidural group. Respiratory depression (RR<9 or SpO2 <90%) was not found in both groups. Sedation scores were significantly higher in the PCA remifentanil group, P<0.05. Incidence of nausea and vomiting was similar between the two groups, without significant difference. PCA remifentanil was inferior to epidural analgesia with respect to pain scores at all time points, but without significant difference in patient satisfaction between the two groups. Conclusion. Intravenous patient-controlled analgesia with remifentanil provides satisfactory level of labor analgesia, with lower SpO2 and more sedation. It could be an excellent alternative to epidural analgesia but continuous monitoring and oxygen supply is mandatory.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"104 - 99"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41428702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Durnev, V. Filipče, Aleksandra Gavrilovska Brzanov, Maja Mojsova Mijovska, Marina Temelkovska Stevanovska
Abstract Introduction. Cerebral oxymetry obtained with Near Infrared Spectroscopy (NIRS) provides noninvasive monitoring of microvasculature in the brain allowing for early recognition and preventive treatment of impaired cerebral oxygenation in traumatic brain injuries. Optimizing cerebral oxygenation is advocated to improve outcome in traumatic brain injured (TBI) hence the goal of this study was to determine the benefit of non invasive monitoring of cerebral oxygenation. Methods. Noninvasive monitoring was conducted in fifteen patients with traumatic brain injury. The values and changes in cerebral oxymetry were analyzed and compared with others tracked parameters: Glasgow Coma Scale on admission to determine the severity of traumatic brain injuries, systolic arterial blood pressure, mean arterial blood pressure, pulse oxymetry, and regular laboratory test. Regional cerebral oxygenation was measured using cerebral oxymetar INVOS 5100 Somanetics®. Results. According to obtained data, we noticed that any change in hemodynamic profile directly influenced the regional cerebral oxygen saturation. Higher changes in values of 15 % and more from basal ones correlate with unfavorable outcome as neurologic sequels. Decreased values of rSO2 in our study were rectified with several simple interventions. In our cases parameter which was most prominent cause for disturbed rSO2 was decreased mean arterial blood pressure. Conclusion. Stable hemodynamic profile leads to optimized cerebral oxygenation. Monitoring the regional oxygen saturation influenced by several factors is important step for forehanded detection of adverse secondary brain injuries. NIRS technology as monitoring system has potential to have diagnostic value and enable right therapeutic decisions and consequently better prognosis in TBI. Continued study of the benefits of cerebral oxygen monitoring is warranted.
{"title":"Cerebral Oxygenation Non Invasive Monitoring in Traumatic Brain Injury - A Pilot Study","authors":"V. Durnev, V. Filipče, Aleksandra Gavrilovska Brzanov, Maja Mojsova Mijovska, Marina Temelkovska Stevanovska","doi":"10.1515/mmr-2017-0019","DOIUrl":"https://doi.org/10.1515/mmr-2017-0019","url":null,"abstract":"Abstract Introduction. Cerebral oxymetry obtained with Near Infrared Spectroscopy (NIRS) provides noninvasive monitoring of microvasculature in the brain allowing for early recognition and preventive treatment of impaired cerebral oxygenation in traumatic brain injuries. Optimizing cerebral oxygenation is advocated to improve outcome in traumatic brain injured (TBI) hence the goal of this study was to determine the benefit of non invasive monitoring of cerebral oxygenation. Methods. Noninvasive monitoring was conducted in fifteen patients with traumatic brain injury. The values and changes in cerebral oxymetry were analyzed and compared with others tracked parameters: Glasgow Coma Scale on admission to determine the severity of traumatic brain injuries, systolic arterial blood pressure, mean arterial blood pressure, pulse oxymetry, and regular laboratory test. Regional cerebral oxygenation was measured using cerebral oxymetar INVOS 5100 Somanetics®. Results. According to obtained data, we noticed that any change in hemodynamic profile directly influenced the regional cerebral oxygen saturation. Higher changes in values of 15 % and more from basal ones correlate with unfavorable outcome as neurologic sequels. Decreased values of rSO2 in our study were rectified with several simple interventions. In our cases parameter which was most prominent cause for disturbed rSO2 was decreased mean arterial blood pressure. Conclusion. Stable hemodynamic profile leads to optimized cerebral oxygenation. Monitoring the regional oxygen saturation influenced by several factors is important step for forehanded detection of adverse secondary brain injuries. NIRS technology as monitoring system has potential to have diagnostic value and enable right therapeutic decisions and consequently better prognosis in TBI. Continued study of the benefits of cerebral oxygen monitoring is warranted.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"113 - 118"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46007150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maja Tankoska, D. Jakimovski, A. Stamatova, A. Starova, N. Biljanovska, Z. Guchev, M. Krstevska-Konstantinova
Abstract Plethora of pediatric autoimmune, dermatological, neurological and atopic disease require chronic administration of steroid medication. Long-term use of corticosterioids can result in both local (atrophy of the skin, hypertrichosis, and telangiectasia) and systemic side effects (hypothalamic-pituitary-adrenal (HPA) axis disturbance, risk of infections). We report a case of 3.5-year-old boy, who developed Cushing syndrome and secondary adrenal insufficiency after corticosteroid cream maltreatment of his psoriasis. After initial hospitalization and recovery, physiological doses of hydrocortisone were used to normalize the HPA axis. In order to prevent Cushing syndrome development, adrenal insufficiencies, and secondary infections, precaution in use of steroid therapy in early childhood must be exercised.
{"title":"Iatrogenic Adrenal Failure Due to Corticosteroid-Treated Psoriasis: Pediatric Case Report","authors":"Maja Tankoska, D. Jakimovski, A. Stamatova, A. Starova, N. Biljanovska, Z. Guchev, M. Krstevska-Konstantinova","doi":"10.1515/mmr-2017-0025","DOIUrl":"https://doi.org/10.1515/mmr-2017-0025","url":null,"abstract":"Abstract Plethora of pediatric autoimmune, dermatological, neurological and atopic disease require chronic administration of steroid medication. Long-term use of corticosterioids can result in both local (atrophy of the skin, hypertrichosis, and telangiectasia) and systemic side effects (hypothalamic-pituitary-adrenal (HPA) axis disturbance, risk of infections). We report a case of 3.5-year-old boy, who developed Cushing syndrome and secondary adrenal insufficiency after corticosteroid cream maltreatment of his psoriasis. After initial hospitalization and recovery, physiological doses of hydrocortisone were used to normalize the HPA axis. In order to prevent Cushing syndrome development, adrenal insufficiencies, and secondary infections, precaution in use of steroid therapy in early childhood must be exercised.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"140 - 142"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43845284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. P. Cvetkovska, A. Taravari, N. Baneva, D. Nikodijevik, Coskun Kerala, A. Andonovski, B. Andonovska
Abstract Introduction. Among 2.8-18.7% of the patients that suffered from spontaneous intracerebral hemorrhage (ICH) develop seizures. Previous studies suggest that most important contributors to developing subsequent seizures are: volume and localization of hematoma, cortical involvement and age. Aims: To determine the occurrence of new epileptic seizures in patients with spontaneous intracerebral hemorrhage and to analyze it with respect to the patient’s age, gender, presence of premorbid risk factors, localization of the hematoma and the type of the seizures. Methods. This study is retrospective in design, with study population of 308 patients with spontaneous intracerebral hemorrhage admitted to our clinic in the period between 2008 and 2014. Analyzed premorbid risk factors for ICH are: hypertension, smoking, alcohol uptake. According to the computer tomography (CT) of brain findings the patients was divided in two groups: lobar and thalamic (deep). By the time of presents of seizures, they were classified as early (within 1 week of ICH) or late (more than 1 week after ICH). Also we analyzed the seizures type and we divided them in four groups: simple partial, partial complex, secondary generalized and tonic clonic generalized seizures. Results. Arterial hypertension was revealed in 78% of the patients with spontaneous supratentorial ICH. Epileptic seizures developed in 8.2% of analyzed patients, most of them in the first week of brain bleeding. Lobar ICH had 78.6% of the patients, with frontal localization was 44% of patients with lobar ICH, and most of them had simple partial and partial complex seizures. Conclusion. Cortical involvement, large volume of hematoma, may be a factor for provoked seizures, especially in the first days of brain bleeding.
{"title":"Intracerebral Hemorrhage and Epileptic Seizures: Frequency, Localization and Seizures Types","authors":"D. P. Cvetkovska, A. Taravari, N. Baneva, D. Nikodijevik, Coskun Kerala, A. Andonovski, B. Andonovska","doi":"10.1515/mmr-2017-0020","DOIUrl":"https://doi.org/10.1515/mmr-2017-0020","url":null,"abstract":"Abstract Introduction. Among 2.8-18.7% of the patients that suffered from spontaneous intracerebral hemorrhage (ICH) develop seizures. Previous studies suggest that most important contributors to developing subsequent seizures are: volume and localization of hematoma, cortical involvement and age. Aims: To determine the occurrence of new epileptic seizures in patients with spontaneous intracerebral hemorrhage and to analyze it with respect to the patient’s age, gender, presence of premorbid risk factors, localization of the hematoma and the type of the seizures. Methods. This study is retrospective in design, with study population of 308 patients with spontaneous intracerebral hemorrhage admitted to our clinic in the period between 2008 and 2014. Analyzed premorbid risk factors for ICH are: hypertension, smoking, alcohol uptake. According to the computer tomography (CT) of brain findings the patients was divided in two groups: lobar and thalamic (deep). By the time of presents of seizures, they were classified as early (within 1 week of ICH) or late (more than 1 week after ICH). Also we analyzed the seizures type and we divided them in four groups: simple partial, partial complex, secondary generalized and tonic clonic generalized seizures. Results. Arterial hypertension was revealed in 78% of the patients with spontaneous supratentorial ICH. Epileptic seizures developed in 8.2% of analyzed patients, most of them in the first week of brain bleeding. Lobar ICH had 78.6% of the patients, with frontal localization was 44% of patients with lobar ICH, and most of them had simple partial and partial complex seizures. Conclusion. Cortical involvement, large volume of hematoma, may be a factor for provoked seizures, especially in the first days of brain bleeding.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"119 - 122"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42043425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Kjaev, Jana Kjaeva Nivicka, S. Kjaeva, D. Karadjova, Irena Aleksioska, A. Daneva, G. Dimitrov
Abstract Introduction. Preeclampsia presents a medical condition in pregnancy that is manifested with increased blood pressure and protein urine. Ocular involvement is rare. Retinal detachment in preeclampsia is a rare complication; it only occurs in 1-2% of severe preeclampsia but in 10% of those with eclamptic seizures. Case report. A pregnant patient G1P0 visited the outpatient clinic of the University Clinic for Ophthalmology complaining on visual disturbances. The chief complaint was blurred vision and headaches. She was in 31 week of gestation and complained that she had increased blood pressure over the last month. After initial assessment she was suspected of central serous retinal ablation (CSCR). Ocular ultrasound and posterior segment OCT (optical coherence tomography) confirmed the diagnosis. Treatment and outcome. Obstetric examination confirmed high blood (TA180/130) pressure with dipstick urine showing(+++). Unfortunately, the ultrasound showed an eutrophic pregnancy in 31 g.w. with fetus mortus inutero. The patient was administered to the intensive care unit. She had an ophthalmologic check-upat 2 weeks and one month post-partum that showed regression and visual acuity was getting better. The final check-up after 6 months revealed that retina was in place with no subretinal substantial fluid and no macular edema. Conclusion. Serous retinal detachment is a rare complication of preeclampsia. In most case it resolves spontaneously few weeks post delivery.
{"title":"Bilateral Serous Retinal Detachment in Preeclampsia: Case Report","authors":"I. Kjaev, Jana Kjaeva Nivicka, S. Kjaeva, D. Karadjova, Irena Aleksioska, A. Daneva, G. Dimitrov","doi":"10.1515/mmr-2017-0026","DOIUrl":"https://doi.org/10.1515/mmr-2017-0026","url":null,"abstract":"Abstract Introduction. Preeclampsia presents a medical condition in pregnancy that is manifested with increased blood pressure and protein urine. Ocular involvement is rare. Retinal detachment in preeclampsia is a rare complication; it only occurs in 1-2% of severe preeclampsia but in 10% of those with eclamptic seizures. Case report. A pregnant patient G1P0 visited the outpatient clinic of the University Clinic for Ophthalmology complaining on visual disturbances. The chief complaint was blurred vision and headaches. She was in 31 week of gestation and complained that she had increased blood pressure over the last month. After initial assessment she was suspected of central serous retinal ablation (CSCR). Ocular ultrasound and posterior segment OCT (optical coherence tomography) confirmed the diagnosis. Treatment and outcome. Obstetric examination confirmed high blood (TA180/130) pressure with dipstick urine showing(+++). Unfortunately, the ultrasound showed an eutrophic pregnancy in 31 g.w. with fetus mortus inutero. The patient was administered to the intensive care unit. She had an ophthalmologic check-upat 2 weeks and one month post-partum that showed regression and visual acuity was getting better. The final check-up after 6 months revealed that retina was in place with no subretinal substantial fluid and no macular edema. Conclusion. Serous retinal detachment is a rare complication of preeclampsia. In most case it resolves spontaneously few weeks post delivery.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"71 1","pages":"143 - 145"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42284395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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